MEDICARE: JUDITH M SKONER MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	MD423272	PA
2	207Y00000X	Otolaryngology Physician	21802	SC
3	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	21802	SC
4	207YS0123X	Facial Plastic Surgery Physician	21802	SC

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1316935489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH M SKONER MD

Provider Business Mailing Address
First Line	:	PO BOX 751461
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1461
Country	:	US
Telephone Number	:	843-792-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	171 ASHLEY AVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-0001
Country	:	US
Telephone Number	:	843-792-1414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	06/13/2016

MUSC DIVISION OF TRANSPLANT SURGERY , 96 JONATHAN LUCAS ST; CSB 409
CHARLESTON, SC
29425-0001

Practice Phone: 843-792-2724
Practice Fax: 843-792-8596